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PubMed1978

Mortality from malignant tumours of bone and Paget's disease in the United States and in England and Wales.

Changes in death rates from malignant tumours of bone among successive cohorts in the U S A and in England and Wales are shown to be remarkably similar. Since cohorts born in the 1870's there have been simultaneous and equal declines in both countries and in both sexes. Comparable cohort trends are also shown for Paget's disease, although the death rates in the U S A are only about one-fifth of those in England and Wales.

Adolescent↗
PubMed1980

A comparison of trends of coronary heart disease mortality in Australia, USA and England and Wales with reference to three major risk factors-hypertension, cigarette smoking and diet.

A comparison has been made of the recent changes in coronary heart disease mortality in Australia, the USA, and in the United Kingdom (England and Wales). Sharp declines in mortality dating from 1966 in Australia and from 1968 in the USA in both sexes contrast with a persistent increase in men in England and Wales until 1972 (after which a sight fall occurred) and a consistent slight fall in women since 1950. An investigation has been made of changes in 3 major risk factors-hypertension, cigarette smoking and diet in the 3 countries in an attempt to determine to what extent such changes might correlate with the different patterns of mortality. There has been a progressive and similar fall in mortality due to hypertension in both sexes in all 3 countries since 1950. There was a rise in cigarette smoking in all 3 countries from 1947 followed by a fall in the USA from 1963 and a more recent fall in men in Australia. There has been a levelling off of smoking in the United Kingdom in middle-aged and older men but not in women where smoking rates have increased from 1950 since when there has been a progressive slight fall in overall coronary heart disease mortality (although there is evidence of a recent rise in younger women.) Changes in dietary constituents (meat, eggs, milk and cheese, butter or margarine) have been examined by reference to aggregate consumption data. In Australia and the USA increases in vegetable fat consumption have occurred since 1950 with a reduction in animal fat in Australia but not in the USA. In the United Kingdom increases in vegetable fat have not been observed while there has been some increase in animal fat. It is concluded that the different patterns of coronary heart disease mortality in the 3 countries do correlate to some extent with changes in diet and cigarette smoking.

Adult↗
PubMed2003

Antibiotic susceptibilities of Gram-positive anaerobic cocci: results of a sentinel study in England and Wales.

OBJECTIVE: A sentinel study was carried out to determine the antimicrobial susceptibilities of Gram-positive anaerobic cocci (GPAC) freshly isolated from clinical material in diagnostic laboratories in England and Wales. METHODS: A total of 113 GPAC isolates consisting predominantly of current or former members of the genus Peptostreptococcus was obtained from 17 sentinel laboratories in England and one in Wales. Minimum inhibitory concentrations (MICs) of 10 antimicrobial agents were determined by the Etest method. The agents tested were: penicillin, tetracycline, erythromycin, cefoxitin, clindamycin, chloramphenicol, imipenem, co-amoxiclav, piperacillin/tazobactam and metronidazole. MIC50 and MIC90 values for each drug-species combination were calculated whenever suitable numbers of each species were obtained. RESULTS: Excellent spectra of activity (0% resistance) against GPAC were seen for metronidazole, piperacillin/tazobactam, cefoxitin, imipenem and chloramphenicol. Low degrees of resistance to co-amoxiclav (3.5%), clindamycin (7.1%), penicillin (7.1%) and significant degrees of resistance to tetracycline (41.6%) and erythromycin (27.4%) were detected. Some examples of putative macrolide-lincosamide linked resistance were noted in seven (6.2%) isolates of GPAC. CONCLUSION: This study is one of the largest susceptibility studies specifically on GPAC carried out to date and the resulting data may be of value to those involved in the empirical treatment of infections involving Gram-positive anaerobic cocci.

Anti-Bacterial Agents↗
PubMed2005

Real-time PCR detection and frequency of 16S rDNA mutations associated with resistance and reduced susceptibility to tetracycline in Helicobacter pylori from England and Wales.

OBJECTIVES: To investigate the occurrence of 16S rDNA mutations associated with resistance or reduced susceptibility to tetracycline in Helicobacter pylori isolated in England and Wales, and to develop a real-time PCR assay to detect these DNA polymorphisms from culture and gastric biopsies. METHODS: Tetracycline susceptibility was determined by disc diffusion. The MIC of isolates with reduced susceptibility was determined by Etest and agar dilution methods. The 16S rDNA of these isolates was sequenced and resistance-associated mutations identified. A LightCycler assay developed to detect these mutations was applied to DNA extracted from culture and gastric biopsies. RESULTS: From 1006 isolates of H. pylori examined, 18 showed reduced susceptibility to tetracycline. Of these, three were resistant (>or=4 mg/L). Mutations in 16S rDNA were detected in 10 of the reduced susceptibility isolates: one double base mutation of A926T/A928C, one A926C, one A928C; and seven A926G. The first two polymorphisms were novel and had not been reported from clinical isolates previously. The LightCycler assay identified each of the 10 isolates with 16S rDNA mutations, but did not detect polymorphisms in 100 tetracycline-susceptible H. pylori isolates. The assay correctly determined the tetracycline susceptibility of H. pylori in 20 gastric biopsy samples. CONCLUSIONS: Mutations in 16S rDNA were detected in H. pylori isolated in England and Wales with reduced susceptibility to tetracycline, but resistance to this antibiotic was uncommon. We show molecular-based susceptibility testing for tetracycline is possible direct from biopsy material.

DNA, Ribosomal↗
PubMed2002

Effectiveness of community-based salaried orthodontic services provided in England and Wales.

OBJECTIVES: To assess the effectiveness of the salaried Community Orthodontic Services in England and Wales, using occlusal indices, and to determine the predictors of treatment outcome. DESIGN: A retrospective investigation. A random stratified sample of districts where Community Orthodontic Services are provided was selected and visited during 1997. METHOD: All community orthodontists in England and Wales, and CDS managers who could be identified were asked to take part in this study. A stratified random sample of 15 per cent of the districts where community orthodontic services were provided was selected and a sample of the records of treated patients was examined. RESULTS: The orthodontists in the sample were providing treatment for patients clearly in need of treatment. There were, however, some variations between districts. Similarly, when the effectiveness of treatment in terms of dento-alveolar change was evaluated, the mean change in PAR and percentage PAR reduction was high. Again, there were variations between the districts. CONCLUSIONS: The Community Orthodontic Service provides effective orthodontic treatment to many individuals clearly in need of that treatment. The most significant predictor of treatment outcome was the use of two-arch fixed appliances, which produced the best treatment outcome

Bias↗
PubMed2000

Trends in epilepsy mortality in England and Wales and the United States, 1950-1994.

The aim of this study was to analyze time trends in epilepsy mortality in England and Wales and the United States between 1950 and 1994. The authors calculated age- and sex-specific epilepsy mortality rates for the nine quinquennia from 1950-1954 to 1990-1994. Mortality rates were modeled as a function of age, period of death, and cohort of birth by using Poisson regression techniques. From 1950 to 1994, there were more than 110,000 deaths from epilepsy in the two countries. The secular trends in mortality were similar for both sexes and in both countries. Among people younger than age 20 years, epilepsy mortality declined steeply after 1950. For young and middle-aged adults, the rate of decline was lower. In the geriatric population, mortality declined between 1950 and 1974 but then increased. The Poisson model showed pronounced birth cohort effects. In the United States, epilepsy mortality fell with each successive birth cohort after 1905. In England and Wales, there was a similar decline in birth cohort mortality after 1905 for women but not until after 1950 for men. The pronounced birth cohort effect supports explanations that focus on antenatal and developmental factors as the cause for the decline in epilepsy mortality in all but the oldest age groups between 1950 and 1994.

Adolescent↗
PubMed1985

Declining fertility in England and Wales as a major cause of the twentieth century decline in mortality. The role of changing family size and age structure in infectious disease mortality in infancy.

The decline in infectious disease mortality in England and Wales beginning about 1880 has been attributed to improved nutrition, hygiene, and sanitation. Such an explanation does not adequately explain the lack of improvement in infant and diarrheal disease mortality before 1900 nor the abrupt subsequent decline. A hypothesis was proposed that the decline in fertility rate was a major cause of the decline in infant mortality by raising the median age at infection. The hypothesis could only be tested indirectly. A review of morbidity data demonstrates the importance of family characteristics on the median age at infection for measles, pertussis, and common respiratory illness. The association of parity with infectious disease mortality supports the hypothesis. A method was developed for estimating the change in birth order distribution resulting from declining fertility. Using 1949-1950 data, it was shown that declining fertility could account for at least a 24% decline in postneonatal mortality due to bronchitis and pneumonia. Age-specific measles mortality rates are consistent, with an increase in age at infection. Declining fertility appears to have played a major role in the decline in infectious disease mortality in England and Wales by increasing the median age at infection.

Adolescent↗
PubMed2000

Patients and procedures in short-stay independent hospitals in England and Wales, 1997-1998.

BACKGROUND: Private hospitals' activities are not routinely reported, so what services they provide and for whom is not known. This study describes the clientele and case-mix of independent hospitals in England and Wales in 1997-1998. METHOD: Person, clinical and funding data were collected on samples of patients admitted to 215 of 221 independent hospitals open in 1997-1998. Sample numbers were weighted to reflect sampling duration, region, season and non-response. RESULTS: A total of 37,434 sampled records represented 828,422 admissions: 406,843 in-patients (5 per cent fewer than in 1992-1993) and 421,580 day cases (69 per cent more); 806,509 were residents of England and Wales (up 24 per cent); 16,628 came from overseas (down 20 per cent). Numbers increased in all age groups except children; 25 per cent were 65 or over (18 per cent in 1992-1993). The commonest procedures were abortion (11 per cent), endoscopy of the gastro-intestinal tract (10 per cent) or joints (5 per cent), lens operations (5 per cent), hernia repairs (3 per cent), and other common National Health Service (NHS) elective operations. The NHS funded 84,561 patients (11 per cent of the total) including 41,942 non-abortion cases (6 per cent). A total of 540,996 (76 per cent) paid through insurance; 119,101 (17 per cent) were self-funded including 30 per cent of the over-75s. Ninety-five per cent of patients went home, 0.3 per cent died and 0.2 per cent were transferred to NHS hospitals. CONCLUSIONS: Demand for short-stay independent hospital care is rising. The clientele is becoming older, and readier to pay out of pocket. Clinical activity is mainly surgical and similar to NHS elective surgical demand. One year's caseload equals 10 weeks' elective admissions to NHS hospitals, in that sense relieving the NHS. The scale of transfer to NHS hospitals (three per day) is small.

Adolescent↗
PubMed2003

Equity of access to tertiary hospitals in Wales: a travel time analysis.

BACKGROUND: The objective of the study was to investigate the implications for equity of geographical access for population subgroups arising from hypothetical scenarios of change in configuration of National Health Service tertiary hospital service provision located in Wales. METHODS: For each of three scenarios, the status quo and centralization of services to one of two locations, we used a travel time road length matrix in geographical information software to calculate the proportion of the population living within 30, 60, 90 and 120 min travel of each hospital site and the associated mean, median and 90th percentile travel times. We analysed data for the total resident population of Wales, for residents aged 75 or more years, for residents of the most deprived 10 per cent of enumeration districts, and for residents of rural areas. RESULTS: Centralization of services reduces geographical access for all population subgroups. Access varies between population subgroups, both between and within different scenarios of service configuration. A change in service configuration may improve access for one subgroup but reduce access for another. The interpretation may also vary according to whether the defined cut point for comparing access is based on short or long travel times. Measurements of absolute and relative access are sensitive to the assumed travel speeds. CONCLUSION: Access for the total population does not imply equity of access for subgroups of the population. Comparisons of access between scenarios are dependent on which measure of access is the indicator of choice. Results are sensitive to the road network travel speeds and further local validation may be necessary. This method can provide explicit information to health service planners on the effects on equity of access from a change in service configuration.

Catchment Area, Health↗
PubMed2005

Geographical distribution of road traffic deaths in England and Wales: place of accident compared with place of residence.

BACKGROUND: There are two sources of information on road traffic mortality in England and Wales: ONS records giving the place of residence and police records giving the place of the accident. Use of the police records has been limited by the lack of an obvious denominator to control for population at risk. This study compares the two measures and explores the implications of using the same population denominator for both. METHODS: The number of road traffic deaths occurring in 403 local authority districts in England and Wales during 1995-1999 was compared to the number of deaths to residents in the same period. Both numbers were related to the expected number of deaths to residents and selected environmental risk factors using regression techniques. RESULTS: Large differences were found between the number of deaths in each district and the number of deaths to residents. The expected number of deaths to residents was the strongest predictor of both observed totals. The number of deaths in the district and the number divided by expected deaths of residents were highly predictable from road accident risk factors, but the number of deaths to residents and the conventional SMR were not. CONCLUSION: Information on the place of residence of road traffic accident fatalities does not show true variations in accident risk. Police records are better for this purpose. The expected number of deaths to residents estimate provides a partial but effective and unbiased control for population effects.

Accidents, Traffic↗
PubMed2005

Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a 'Scottish Effect'.

OBJECTIVES: To determine the degree to which changing patterns of deprivation in Scotland and the rest of Great Britain between 1981 and 2001 explain Scotland's higher mortality rates over that period. DESIGN: Cross-sectional analyses using population and mortality data from around the 1981, 1991 and 2001 censuses. SETTING: Great Britain (GB). PARTICIPANTS: Populations of Great Britain enumerated in the 1981, 1991 and 2001 censuses. MAIN OUTCOME MEASURES: Carstairs deprivation scores derived for wards (England and Wales) and postcode sectors (Scotland). Mortality rates adjusted for age, sex and deprivation decile. RESULTS: Between 1981 and 2001 Scotland became less deprived relative to the rest of Great Britain. Age and sex standardized all-cause mortality rates decreased by approximately 25% across Great Britain, including Scotland but mortality rates were on average 12% higher in Scotland in 1981 rising to 15% higher in 2001. While over 60% of the excess mortality in 1981 could be explained by differences in deprivation profile, less than half the excess could be explained in 1991 and 2001. After adjusting for age, sex and deprivation, excess mortality in Scotland rose from 4.7% (95% CI: 3.9% to 5.4%) in 1981 to 7.9% (95% CI: 7.2% to 8.7%) in 1991 and 8.2% (95% CI: 7.4% to 9.0%) in 2001. All deprivation deciles showed excess indicating that populations in Scotland living in areas of comparable deprivation to populations in the rest of Great Britain always had higher mortality rates. By 2001 the largest excesses were found in the most deprived areas in Scotland with a 17% higher mortality rate in the most deprived decile compared to similarly deprived areas in England and Wales. Excess mortality in Scotland has increased most among males aged <65 years. CONCLUSIONS: Scotland's relative mortality disadvantage compared to the rest of Great Britain, after allowing for deprivation, is worsening. By 1991 measures of deprivation no longer explained most of the excess mortality in Scotland and the unexplained excess has persisted during the 1990s. More research is required to understand what is causing this 'Scottish effect'.

Adolescent↗
PubMed1997

Mortality from aortic aneurysm in migrants between counties of England and Wales: evidence for causes acting early in life.

We assessed whether the causes of aortic aneurysm underlying its distinctive geographical distribution in England and Wales act early or later in life from the OPCS data on deaths in England and Wales during April 1969-December 1972. From these data, we calculated proportional mortality ratios (PMRs) for aortic aneurysm by county of birth and county of death, for men and women aged 45-74. Among people resident in the county of their birth, PMRs for aortic aneurysm by county ranged from 31 in Pembrokeshire to 194 in Surrey. Among 'migrants', who died in a different county from that in which they were born, PMRs by place of death varied from 85 in the group of counties which had the lowest mortality in non-migrants to 111 in those with the highest mortality in non-migrants, and PMRs by place of birth varied from 74 in counties with lowest mortality in non-migrants to 113 in those with highest mortality in non-migrants. After adjustment for place of residence at death, the relation of mortality to place of birth was highly significant statistically (P < < 0.001). These findings indicate important causes of aortic aneurysm acting early in life, perhaps related to the formation of elastin in the arterial wall.

Aged↗
PubMed1987

Mortality from systemic lupus erythematosus in England and Wales, 1974-1983.

Mortality rates from systemic lupus erythematosus (SLE) in England and Wales were estimated from Office of Population Censuses and Surveys data from 1974 to 1983, by age and sex. Age-specific average annual mortality rates showed unimodal distributions for both sexes with maximal death rates in the 65-74-year age groups. The overall age-adjusted mortality rate for females was about four times that in males, 3.94 versus 1.02 per million person-years, respectively. Examination of individual age-specific rates showed an early sharp rise in females producing female-to-male ratios which exceeded 10 in the 25-34-year age group. Age-adjusted annual mortality rates in females significantly declined during the 10-year interval studied from 4.47 to 2.99 per million person-years (p = 0.0083). These patterns of mortality from SLE observed in England and Wales are comparable to those reported among Caucasians in the United States during a similar time period.

Adolescent↗
PubMed1997

Bacterial joint infections in England and Wales: analysis of bacterial isolates over a four year period.

Data from 1158 cases of septic arthritis reported to the Public Health Laboratory Service (PHLS) Communicable Disease Control Centre (CDSC) from England and Wales over a 4 yr period (January 1990 December 1993) are presented. Reports where a bacterial organism was isolated from synovial fluid, or where an organism was isolated from blood cultures where a diagnosis of septic arthritis was reported, were examined. Reports of infection were more common in children (12.7% of infections were in the under 10 age group) and the elderly (54.7% aged 60 or over), and were higher in males in all age groups except in the elderly. The most common causative organisms remain staphylococcal and streptococcal species, comprising 40.6% (470) and 28% (324) of cases, respectively. The most common streptococci seen were Streptococcus pneumoniae and Lancefield group A beta-haemolytic Streptococcus organisms, 60.8% (197/324), although group B, C and G organisms accounted for 33.6% of streptococcal isolates (109/324). Haemophilus influenzae septic arthritis is not exclusive to children as 23.2% (16-69) of cases occurred over the age of 15. A total of 48% (635) of isolates were identified from both synovial fluid and blood cultures, 32.6% (378) from joint fluid alone and 12.5% (146) from blood cultures. Although this study excludes cases of septic arthritis where no organism was isolated, it presents important bacteriological information from a large number of isolates from England and Wales over a 4 yr period. Risk factors identified include a joint prosthesis, joint disease/connective tissue disorder. immunosuppression and diabetes.

Adolescent↗
PubMed2003

To relieve the sufferings of humanity, irrespective of party, politics or creed?: conflict, consensus and voluntary hospital provision in Edwardian South Wales.

This article examines the provision of voluntary hospital facilities for injured workers in the mining valleys of Edwardian South Wales. It considers the co-operation and conflict that characterized efforts to establish hospitals, and examines the attitudes and activities of workers, employers, and other interested groups. Despite certain instances of disagreement and conflict, this article demonstrates the significant levels of co-operation and consensus that characterized the efforts of employers and workers to provide communities with hospital facilities. This co-operation was perhaps surprising considering the bitter industrial conflict and social unrest of that period. The article uses this material to question assertions that hospitals reflect the social and political milieus of the communities in which they were situated and argues that the social relations produced by hospital provision sometimes coincided with wider social and industrial relations, but at other times differed from them or transcended them. Furthermore, the article demonstrates that the co-operation between employers and workers in the provision of hospitals in Edwardian South Wales did not stabilize social and industrial relations in the way that historians of associational voluntarism in other contexts have found.

Accidents, Occupational↗
PubMed1993

HIV infection in injecting drug users attending centres in England and Wales, 1990-1991.

OBJECTIVE: To monitor trends in HIV infection and associated risk behaviours in injecting drug users (IDU) in England and Wales. DESIGN: Ongoing voluntary unlinked anonymous cross-sectional survey. METHOD: IDU attending centres in 1990 and 1991 were invited to complete a brief questionnaire requesting demographic and behavioural information, and to provide a saliva sample to be tested for antibodies to HIV and to the core antigen of hepatitis B virus (HBV). RESULTS: In 1990, 1.2% (19 out of 1543) of samples from 33 centres, and in 1991 1.8% (25 out of 1417) of samples from 37 centres contained antibody to HIV. Antibody t9 HBV core-antigen was found in 33 and 31% of IDU in 1990 and 1991, respectively. The prevalence of HIV infection in IDU attending centres in London (4.2%) was higher than in those attending centres elsewhere (0.8%). The prevalence of HIV infection in 1991 varied between individual centres from 0 to 10.6%, and at many centres outside London no IDU were infected with HIV. In the same year the prevalence of past infection with HBV varied from 14 to 54%, and IDU who had evidence of HBV infection were found among attenders in nearly all centres. The prevalences of sharing injecting equipment and risky sexual behaviour were high at many centres. The prevalence of HIV infection was higher in IDU who had started to inject in 1985 or earlier, than in those who started injecting later. In each year, approximately half the IDU surveyed reported having had a voluntary confidential HIV-antibody test, and the prevalence of HIV infection was five times higher in those tested than in those who had not been tested. CONCLUSIONS: HIV prevalence in IDU attending centres in England and Wales was low in 1990-1991. There is some indication that IDU have modified their injecting or sexual behaviour, but even at existing reduced levels of risk behaviour, transmission can occur in HIV is introduced into previously unexposed groups.

Adolescent↗
PubMed2002

The triumph and continuing struggle of nurse practitioners in New South Wales, Australia.

Finally nurse practitioners in New South Wales, Australia, are legally recognized after more than a decade of struggle. In this article the authors provide an update on the nurse practitioner movement, including the continuing conflict with the medical profession as nursing strives to achieve full implementation and acceptance of the nurse practitioner role in New South Wales. Discussion includes nurse practitioner role legislation and authorization process. The issues and concerns expressed by the medical and nursing professions are outlined, and the authors make recommendations to strengthen and support the advanced professional role and status of nurse practitioners.

Humans↗
PubMed1998

Patients consulting with Crohn's disease in primary care in England and Wales.

OBJECTIVE: To determine annual incidence and prevalence for patients consulting their GP because of Crohn's disease in England and Wales and compare demographic details with matched controls. DESIGN: We used the fourth Morbidity Statistics in General Practice study (MSGP-4) which covered 468 042 person-years during a 12-month period in 1991-92. METHODS: All GPs reporting a patient with Crohn's disease in MSGP-4 were sent a questionnaire to confirm the diagnosis and obtain supportive details (surgical, pathological, radiological and/or endoscopic). Data concerning ethnicity, social class, smoking status, living in an urban or rural environment and employment had been collected previously. Conditional logistic regression models were used to analyse the data for cases and matched controls. RESULTS: Three hundred and fifteen patients were reported to have Crohn's disease. Replies were obtained to 251 (80%) questionnaires. The diagnosis of Crohn's disease was confirmed in 184 cases (89%) and refuted in 23 cases (11%) -- details were unavailable for 44 patients. The mean age of patients was 44 years, the female:male ratio was 1.46:1, and 108 (59%) patients had required surgery. Thirty-three of 178 (18.5%) patients were diagnosed within the study period. Hence, this study detected a prevalence for consulting Crohn's disease of 54.6-59.8/100,000 and an annual incidence of 10.1-11.1/100,000 in 1991-92. No significant differences were found between cases (n = 291) and controls (n = 1682) with regard to ethnicity, social class, smoking or living in an urban/rural environment. Patients with Crohn's disease had similar employment levels as controls, but were significantly more likely to be registered as permanently sick, odds ratio 4.01 (CI 2.21-7.29). CONCLUSIONS: This national survey, including 1% of the population, suggests there are approximately 30,600 patients consulting their GP because of Crohn's disease in England and Wales, with 5700 new cases diagnosed per year.

Adolescent↗